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What is an Endodontist and what do they do?

An endodontist is a dentist who has undergone a minimum of 2 years of extra postgraduate training after dental school. An endodontic practice focuses primarily on root canal treatment, related surgery, and treatment of damaged teeth resulting from accidents and injuries.  Endodontists study root canal techniques and procedures in greater depth, for diagnosis and treatment of more difficult cases. For this reason, many dentists choose to refer their patients to endodontists.

Aside from providing treatment, endodontists act as educators. It is important that patients understand why they require treatment, what treatment is involved and what they can do to ensure the best possible outcome.  Dr. Cotton and his team believe that a properly informed patient has the best chance of achieving the optimal result for their tooth.

What is Endodontics?

Endodontics is a specialty of dentistry that deals with diseases of the dental pulp and its supporting structures. Endodontists are dentists with special post-graduate training in this field.  Endodontists generally limit their practice to root canal treatment and related surgery.  Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.

Although general dentists can perform endodontic treatment, patients are often referred to an endodontist when treatment is complicated or more difficult than usual.

In order to understand endodontic treatment, it helps to know something about the anatomy of a tooth. Teeth have several layers. The outside layer of the tooth is composed of a hard layer called enamel. Enamel is supported by an inner layer called dentin, which has at its center a soft tissue known as the pulp.

The pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding dentin and enamel during tooth development. The pulp receives its nourishment supply from vessels which enter the end of the root. Although the pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed. In other words, removal of the pulp does not cause the tooth to "die."

Why Would I Need Endodontic Treatment?

Endodontic treatment is necessary when the pulp becomes inflamed or infected. The most common reasons for inflammation or infection are:

  • Deep decay (caries)
  • Exposure of the pulp during decay removal
  • Large fillings that are close to the pulp
  • Crown preparation
  • Cracks or fractures
  • Trauma

If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess. Occasionally your dentist may recommend endodontic treatment even though your tooth does not bother you, in anticipation of future problems.

Signs and Symptoms

There are several typical signs and symptoms that indicate root canal treatment might be necessary. These include prolonged sensitivity to heat or cold, discoloration of the tooth, swelling of the cheek or gums, or tenderness of the tooth or adjacent gums.  Sometimes a "pimple" will form on the gums, indicating infection is draining from the tooth.  It is not unusual for a tooth to be painful or throbbing one day but then asymptomatic the next. Sometimes there are no symptoms at all if the infection is localized and well controlled by your immune system.

How Can Endodontic Treatment help me?

The endodontist removes the inflammed or infected pulp, carefully cleans and shapes the canal system and then seals the canals to prevent re-infection. Many teeth can be treated in a single appointment but some teeth, particularly infected ones, may require two appointments. Once treatment is completed, you may be instructed to return to your dentist for a permanent filling or crown. If restoration of the tooth is simple, we may be able to do it for you at the end of the appointment, if you prefer. The restoration of the tooth is an important part of treatment because it seals the cleaned canals from contamination by saliva, protects the tooth and restores it to function.  It  is extremely important that you return to your general dentist promptly for the restoration.  A delay in following through to complete treatment may reduce the chances of your tooth healing and may lead to the loss of your tooth due to things such as cracks, fractures, or re-infection.  

Will I feel pain during or after the procedure?

Toothache pain is the main reason for patients seeking treatment. Fortunately, modern anesthetics can make the procedure pain free in most cases. Seeking treatment early makes the procedure more comfortable, so don't wait. When caught early, root canal treatment should feel no different than a regular filling. For the first few days after treatment, there may be some sensitivity to biting pressure, especially if there was pain or infection before the procedure. Sometimes over-the-counter anti-inflammatory medications (like Advil) are recommended for a day or two. Endodontists can prescribe other medications but they are rarely required.